Preoperative steroid treatment does not improve markers of inflammation after cardiac surgery in neonates: results from a randomized trial.
Preoperative steroid treatment does not improve markers of inflammation after cardiac surgery in neonates: results from a randomized trial.
复制标题
DOI：
10.1016/j.jtcvs.2013.06.010
复制
发表时间：
2014-03
影响因子：
6
通讯作者：
Spinale, Francis G.
中科院分区：
文献类型：
--
作者：
Graham, Eric M.;Atz, Andrew M.;McHugh, Kimberly E.;Butts, Ryan J.;Baker, Nathaniel L.;Stroud, Robert E.;Reeves, Scott T.;Bradley, Scott M.;McGowan, Francis X., Jr.;Spinale, Francis G.
需要体外循环的新生儿心脏手术导致炎症反应升高。围手术期糖皮质激素给药通常用于减少炎症级联反应，尽管由于给药方法的高度可变性，新生儿心脏手术中对类固醇的细胞因子反应的表征仍然难以捉摸。本随机试验旨在前瞻性评价特定糖皮质激素给药方案对需要体外循环的新生儿心脏手术中炎症标志物的影响。在一项前瞻性双盲试验中，计划进行心脏手术的新生儿被随机分配接受两次剂量（术前和手术前8小时，n=36）或单次剂量（手术中，n=32）甲基强的松龙30 mg/kg/剂量。主要结果是这些类固醇方案对炎症标志物的影响。次要分析评价了特定细胞因子谱与术后临床结局的相关性。单次给药组和两次给药组的患者人口统计学资料、围手术期变量和术前炎症指数相似。两剂甲基强的松龙方案后的术前细胞因子反应与抗炎作用一致，尽管这并没有持续到术后。术前白细胞介素-6、白细胞介素-8、白细胞介素-10和肿瘤坏死因子α的基线水平可预测术后重症监护室和住院时间。只有白细胞介素-8表现出与重症监护室和住院时间相关的术后反应。在标准术中甲泼尼龙剂量基础上增加术前甲泼尼龙剂量并不能改善新生儿心脏手术后的炎症标志物。新生儿心脏手术术前常规应用糖皮质激素应重新考虑。这是最大的儿科和唯一的新生儿随机试验，检查两种不同的甲泼尼龙给药方案对需要心脏手术的新生儿的抗炎作用。在标准术中甲泼尼龙剂量基础上增加术前甲泼尼龙剂量并不能改善新生儿心脏手术后的炎症标志物。
Neonatal cardiac surgery requiring cardiopulmonary bypass results in a heightened inflammatory response. Perioperative glucocorticoid administration is commonly utilized in attempt to reduce the inflammatory cascade, although characterization of the cytokine response to steroids in neonatal cardiac surgery remains elusive due to highly variable approaches in administration. This randomized trial was designed to prospectively evaluate the effect of specific glucocorticoid dosing protocols on inflammatory markers in neonatal cardiac surgery requiring cardiopulmonary bypass. Neonates scheduled for cardiac surgery were randomly assigned to receive either two-dose (8 hours preoperatively and operatively, n=36) or single dose (operatively, n=32) methylprednisolone at 30mg/kg/dose in a prospective double-blind trial. The primary outcome was the effect of these steroid regimens on markers of inflammation. Secondary analyses evaluated the association of specific cytokine profiles with postoperative clinical outcomes. Patient demographics, perioperative variables and preoperative indices of inflammation were similar between the single and two-dose groups. Preoperative cytokine response after the two-dose methylprednisolone protocol was consistent with an anti-inflammatory effect, although this did not persist into the postoperative period. Pre-medication baseline levels of interleukin-6, interleukin-8, interleukin-10 and tumor necrosis factor alpha were predictive of postoperative intensive care unit and hospital length of stay. Only interleukin-8 demonstrated a postoperative response associated with duration of intensive care unit and hospital stay. The addition of a preoperative dose of methylprednisolone to a standard intraoperative methylprednisolone dose does not improve markers of inflammation following neonatal cardiac surgery. The routine administration of preoperative glucocorticoids in neonatal cardiac surgery should be reconsidered. This is the largest pediatric and only exclusively neonatal randomized trial examining the anti-inflammatory effect of two different methylprednisolone dosing regimens for neonates requiring cardiac surgery. The addition of a preoperative dose of methylprednisolone to a standard intraoperative methylprednisolone dose does not improve markers of inflammation following neonatal cardiac surgery.
登录
查看更多内容
影响因子：
9.1
作者：
Alcaraz, AJ;Manzano, L;Alvarez-Mon, M
通讯作者：
Alvarez-Mon, M
DOI：
10.1016/s0022-5223(99)70331-4
发表时间：
1999-03-01
影响因子：
6
作者：
Lodge, AJ;Chai, PJ;Jaggers, J
通讯作者：
Jaggers, J
影响因子：
37.8
作者：
Schroeder, VA;Pearl, JM;Nelson, DP
通讯作者：
Nelson, DP
影响因子：
4.1
作者：
Allen, Meredith;Sundararajan, Santosh;Macrae, Duncan
通讯作者：
Macrae, Duncan
DOI：
10.1002/cyto.b.10018
发表时间：
2003-07-01
期刊：
Cytometry
影响因子：
--
作者：
Tarnok, Attila;Emmrich, Frank
通讯作者：
Emmrich, Frank